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									<fo:block text-align='right'>Page <fo:page-number /> of <fo:page-number-citation ref-id='last-page' /></fo:block>
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						<fo:inline font-weight='bold' font-size='14pt'>Disclosures Q 1, 2, 3 by Supervisor</fo:inline>
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Text of questions on disclosure statement form:</fo:inline>

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For Individuals:</fo:inline>

							C1 Outside Activities: In calendar year 2008, have you participated in any Outside Activities, (e.g., consulting, scientific advisory board, textbook editing) and/or held any Fiduciary positions (e.g., Director, Trustee) with any Outside Entities that provides, has provided or is likely to provide Goods or Services to Partners, or that are involved with providing Health Care Related Goods or Services? Note:  Some examples of companies that provide Goods or Services to Partners include companies involved in pharmaceutical and medical device manufacturing, biotechnology, information technology, medical education, and hospital and office supplies.

							C2 Equity Interests:  For this question, please note the different time frame, and please exclude holdings in mutual funds, pension funds or 401(k)/403(b) funds where you have no control over the specific stocks in the fund.  As of the last day of last month, did you hold any Equity/stock/stock option or other ownership interests in Outside Entities that provides, has provided, or is likely to provide Goods or Services to Partners, and/or is involved or is likely to be involved in providing Health Care Related Goods or Services. See note above.

							C3 Family's Associations and Equity Interests:  You are only required to disclose those Family Associations and Equity interests of which you have knowledge.  To your knowledge, in calendar year 2008, has any member of your immediate Family or other person living in your household had an Association or relationship, either paid or unpaid, with an Outside Entity that provides, has provided, or is likely to provide Goods or Services to Partners, and/or an Equity/stock/stock option or other ownership interest in an Outside Entity that provides, has provided, or is likely to provide Goods and Services to Partners, and/or any involvement in providing Health Care Related Goods or Services.  See note above.

							C4 Payments for Intellectual Property: In calendar year 2008, have you received any royalties, milestones, or other payments as a result of patents, copyrights, other intellectual property or tangible material, such as biologic or research materials, such as cell lines, reagents, or tissues?
							
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For Trustees:</fo:inline>

C1 Associations:  In the past 12 months, up to and including the present, have you had or do you currently have an Association with or an Equity Interest in a Non-Partners Entity that provides, has provided or is likely to provide Goods or Services to Partners, and/or is involved in providing Health Care Related Goods or Services?

C2 Family Associations and Equity Interests:  To your knowledge, in the past 12 months, up to and including the present, has any member of your family had or does he/she currently have: an Association with an Outside Entity that provides, has provided, or is likely to provide Goods or Services to Partners, and/or an Equity Interest in an Outside Entity that provides, has provided, or is likely to provide Goods or Services to Partners, and/or  is involved in providing Health Care Related Goods or Services?
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Supervisor Name: </fo:inline><xsl:value-of select="/COISummaryReports/@SupervisorName" />
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											<fo:inline font-weight='bold'>C1</fo:inline>
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											<fo:inline font-weight='bold'>C2</fo:inline>
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											<fo:inline font-weight='bold'>C3</fo:inline>
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											<fo:inline font-weight='bold'>C4</fo:inline>
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											<fo:inline font-weight='bold'>Other Activity</fo:inline>
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											<fo:inline font-weight='bold'>Date Received</fo:inline>
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